IPCIT: The Trials and Triumphs of Virtual Therapy during COVID

In March of 2020, the world was forced to make many adjustments for the sake of the health and safety of the larger community.  Children switched to remote learning, many professionals had to work from home, and social interactions became extremely limited.  With all of these changes came new challenges--studies have shown that parental stress that results from a crisis is positively linked to increases in child mental health concerns.  Therefore, all of these changes plus the additional stress that parents have taken on since the beginning of the outbreak have directly impacted the mental health of children.  Specifically, child behavior problems are exacerbated by these stressors.

PCIT was only one form of therapy that made the transition to telehealth services.  However, it had already been adapted to be provided virtually even before the COVID-19 outbreak.  As a practice, PCIT is a wonderful evidence based practice that highlights the importance of the parent-child relationship in the process of treating young children with behavioral challenges.  Before the pandemic, some therapists conducted PCIT virtually--this is referred to as iPCIT.  Therefore, professionals had some understanding about this modality before the era of Zoom meetings and Google Meet conferences.  It was only when many had to adapt to work-from-home that we could really study the clinical implications of iPCIT.  The most pressing question: in the wake of the COVID-19 outbreak, how effective is this virtual form of therapy?   

One of the benefits of iPCIT is that therapists conduct sessions using video platforms.  This enables them to watch the parent-child interaction take place at home instead of in the clinical setting.  Furthermore, the therapist is able to communicate with the parent using an earpiece throughout the session which is extremely useful for parent-coaching.  And the feedback is somewhat encouraging: one study suggests that 82% of the therapists interviewed showed interest in continuing to conduct PCIT virtually after the outbreak.  Some have even stated that the difference between in-person and virtual PCIT is negligible.  Most frequently, however, therapists cite the overwhelming benefits of conducting these sessions within the patient’s home setting.  Instead of parents having to transfer their learned skills from a different setting into the home, they are learning and practicing these new skills that they cultivate during sessions in their natural environment.  Additionally, the therapist can often get a better sense of the home environment which in turn contributes to better treatment for the family.  With this virtual “window” into the life of the patient, therapists might make important observations that they would otherwise lack had these sessions occurred in their practice.   For example, it is easier to see the dynamics of a family during video sessions.  Finally, the switch to iPCIT during COVID led to an increase in access and engagement in PCIT.  This platform for therapy gave more flexibility to families for scheduling.  

While all of this feedback sounds promising, the transition to iPCIT does have its disadvantages.  Perhaps the most blatant issue has to do with accessibility--just as is the challenge with the switch to remote learning, some families simply do not have the technology necessary to participate in video sessions.  Whether this has to do with computers or internet connectivity, not everyone has equal access.  Even for those who have the resources, some have more limited knowledge of how to use such resources.  Of course, there are also the limitations that come with using technology in general-some therapists have commented on poor visibility of the child during the sessions, and they also note that both the parent and child are more easily distracted.

Overall, this experience has called to our attention the limitations and the potential of iPCIT.  Now that therapists have begun to identify the problems with PCIT-both when delivered in person and those that arise when conducted virtually-they can address them accordingly.  In recognizing the strengths of each modality, professionals can hopefully work towards improving both the accessibility of PCIT and the therapy itself.  If there is a silver-lining to this past year and a half of Zoom birthdays, graduations, and work meetings, let it be this step in the right direction for therapy and mental health care.

This post was written by Angelique Simeone, Long Island Behavioral Psychology’s office intern

Cited:

Miya L. Barnett, Marika Sigal, Yessica Green Rosas, Frederique Corcoran, Medini Rastogi, Jason F. Jent, Therapist Experiences and Attitudes About Implementing Internet-Delivered Parent-Child Interaction Therapy During COVID-19, Cognitive and Behavioral Practice, 2021.